Basic Information
| Provider Information | |||||||||
| NPI: | 1558803478 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMISIAL | ||||||||
| FirstName: | CECILE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25911 148TH RD | ||||||||
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| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114222903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9178632889 | ||||||||
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| Practice Location | |||||||||
| Address1: | 451 CLARKSON AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112032054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182453131 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2016 | ||||||||
| LastUpdateDate: | 11/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F 3406501 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.